Jan 23, 2023
Original message below is from January communication, be sure to read about changes to this communication announced in February.
Blue Shield of California has successfully submitted 2020 and 2021 data reports, as required by the Consolidated Appropriations Act, Section 204 – Pharmacy Drug Cost Reporting. Reports were submitted according to the reporting responsibilities previously communicated to group plan sponsors here. This week, Blue Shield will reach out to group plan sponsors, confirming the submission of reports and reminding them to prepare for reports due by June 1, 2023.
Reports were initially due December 27, 2022, however on December 23, 2022, the Tri-Agencies published ACA FAQ Part 56, announcing that enforcement would not be taken against plans or issuers, making good faith efforts to submit reports. The regulatory agencies are also providing a submission grace period through January 31, 2023 and will not consider a plan or issuer to be out of compliance, as long as a good faith submission of 2020 and 2021 data is made on or before that date. Group plan sponsors previously encountering any issues during submission may attempt to resubmit data until the new deadline.
Initially, the regulatory agencies allowed a good faith estimate for D1 Premium and Life Year (D1) data for reference years 2020 and 2021. As a result, Blue Shield made the decision to handle D1 reporting for all groups, except those with carved out pharmacy or stop loss benefits.
Based on the current guidance, however, for the next reports due on June 1, 2023, all group plan sponsors, including those with carved out benefits, will now be required to submit D1. There is a possibility that the Centers for Medicare and Medicaid Services (CMS) may issue further guidance on capturing and reporting D1, depending on the latest reports received, however Blue Shield encourages your clients to prepare for D1 submission to the CMS nonetheless.
Blue Shield understands the challenges group plan sponsors might experience in submitting data to the CMS and are committed to supporting them. In the months to come, they will keep you informed on any new regulatory announcements and provide resources to help your clients navigate the requirements of this mandate.
To learn more, please refer to the CMS Pharmacy Drug Cost Reporting page.
